Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Wednesday, December 5, 2007

Leading Change

Ten years ago this week, I became CIO of CareGroup. On that day, I learned an important lesson about leading change.

Just hours after getting the job I decided that we'd embrace a service oriented architecture (SOA), standardize all desktop/server/storage infrastructure, and implement centrally managed applications. At 8am the next morning, I was scheduled to meet with my 300 staff members and share with them my vision for the future.

Luckily, experienced leaders counseled me on that first day. I discussed my vision with three Board members - Warren McFarlan (Professor at Harvard Business School), John Keane Sr. (CEO of Keane Inc.) and Sam Fleming (CEO of DRI/McGraw Hill). They told me that announcing a strategic plan without engaging all the stakeholders in the process would lead to mixed support and adoption.

Instead of arriving at the 8am meeting with all the answers, I arrived with questions. I explained to the staff that we wanted to improve customer service, encourage innovation, and ensure our work was aligned with the needs of our stakeholders. I challenged them to tell me what they thought we should do. In the first 30 days of my CIO tenure, I met with every staff member in IS as well as every senior manager in CareGroup to gather their priority lists, synthesize their input, and ensure they had a voice in the future. The result was a new IS operating plan focused on getting the basics done right. We clearly communicated the work to be done, the organizational structure which supported that work and the right people to staff the structure. The next step was to implement the changes.

I've long been a fan of John Kotter and his work on leading change in organizations. His broad recommendations to effect change include:

a. Defrost the status quob. Take actions that bring about changec. Anchor the changes in the corporate culture

The planning meetings described above defrosted the status quo. The actions I took to bring about change included:
Create a Vision for Change - the community came together with a vision of a web-centric organization and I broadly communicated it.

Establish a Sense of Urgency - everyone recognized that IT innovation was essential to coordinate clinical care, improve safety and enhance our competitiveness, especially after the merger of Beth Israel and Deaconess

Elicit Executive and Peer Sponsorship - The CEO declared that medication safety, personal health records, and enhanced communication to all levels of the organization were the strategic goals of the entire organization for that year

Empower Employees to Implement Change - we aligned responsibility, accountability and authority throughout the IT organization so that managers had the resources and authority they needed to support our improvement efforts. We created a Special Projects team to coordinate the improvement projects without disrupting day to day operations.

Establish Short-term Goals - we created the first web application in healthcare to share data (with patient consent) among multiple organizations. We created the first web-based provider order entry system, and we created the first personal health record to share all hospital data with patients

Encourage Additional Changes - we created a non-punitive culture in which everyone was encouraged to identify mistakes and opportunities for process improvement

Reinforce Changes Made as Permanent - we built standard processes to deliver service, prioritize new projects, and communicate our multi-year plans to the community

That first year, we implemented strong project management methodologies, eliminated unnecessary work, and focused on getting basic services like email, networks, storage, and electronic result reporting rolled out to everyone in the community. Managing this work required resources, vision, and communication. All the pieces were in place to effect change.

Occasionally, I try to execute a change management project more quickly than usual, bypassing these steps. Whenever I do that I find that adoption of the new technology is delayed, budgets are at risk of overrun, and frustration escalates.

My decade of experience executing change suggests that Kotter was right. Building a guiding coalition, broadly communicating the vision, and celebrating a series of short term successes really works. I've watched projects without vision, resources or communication cause pain and anxiety throughout the organization. The good news is that we now know how to execute change and it is the role of senior management to enforce Kotter's principles in every change project.

5 comments:

Org behavior was the first class we took in my program. Leading change was talked about a lot, with a lot of case study review and papers.

It's all a little too touchy-feely for me, but I've seen the process go terribly wrong. I was doing all the revenue cycle management at a small inpatient psych hospital and new owners took over. They started implementing changes and the veteran employees resisted every step of the way.

It's a tough process to get change pushed correctly. Look at hospitals and hand washing, that's a simple no brainer yet we can't get them to follow correctly sometimes.